Antacids are readily available over the counter. They include such liquid preparations as
Maalox
Mylanta
Amphojel
Tums is an example of a solid antacid.
What are the active ingredients in antacids?
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Generally, antacids are made from a variety of metallic salts. These include magnesium and aluminum. The metallic salts are usually bonded to other salts such as sodium or calcium.
Are there any side effects of antacids?
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Magnesium containing antacids may have a laxative effect. Milk of Magnesia is product made of magnesium and sodium. Aluminum based antacids, such as Amphojel, may have a constipating effect. Many people try to avoid aluminum based products. Aluminum has been associated with Alzheimer’s Disease and Autism, although there is no actual scientific proof.
Taking too much of any antacid, or persons with impaired renal failure who have difficulty excreting waste products, may experience more serious symptoms of mineral toxicities. Rebound hyperacidity may also occur.
What is rebound hyperacidity?
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Rebound hyperacidity is as an increase in gastric acid secretion above the initial levels prior to the administration of the antacid. Rebound hyperacidity phenomenom is similar to rebound nasal congestion following the prolonged use of decongestants.
Is there any preparation prior to administering an antacid?
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Antacids are a suspension and must be vigorously shaken before pouring to ensure even distribution of the suspended particles.
What about the anatacid tablets that dissolve and ‘fizz’ in water?
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Sodium bicarbonate products, either a home mixture of baking soda and water or a commercial product such as Alka-Seltzer, are less safe than the ‘white’ antacids. Sodium bicarbonate is readily absorbed into the system and can easily cause systemic alkalosis. There is also a greater tendancy for rebound hyperacidity. People should be discouraged from using these solutions.
Should an antacid be given prior to a meal, with a meal, or after a meal?
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Antacids can be given at any time without consideration to food. Some patients may find they experience greater relief either before, during, or after a meal, but this is specific to the patient.
How should an antacid be given?
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Since the success of the antacid in raising the pH of the stomach lining is dependant upon the actual surface area it touches, it is best to give an antacid with a full glass of water. This provides a greater coating area of the stomach lining.
What is the onset of action for antacids?
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For most persons, relief occurs within minutes. The duration is only as long as it takes the stomach to build up acid levels again.
Are there any drug – drug interactions with antacids?
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Changing the stomach environment from acidic to alkaline can interfere with many drugs. Giving an enteric coated drug with an antacid will cause that drug to be dissolved in the stomach rather than the small intestine. Some drugs, even if not enteric coated, are better dissolved in an acidic environment. Giving these medications with an antacid will decrease that drug’s absorption and effect. An example of this is tetracycline and some other antibiotics. Other examples include digoxin and dilantin. It is best to always wait two hours between taking an antacid and taking any other medication.
What is a histamine H2 antagonist?
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A histamine H2 antagonist inhibit the stomach cells from secreting gastric acid. Histamine H2 antagonists do not neutralize the stomach contents in any way, they prevent the stomach from secreting acid.
What is the most common use of a histamine H2 antagonist?
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Histamine H2 antagonsits are most commonly used to prevent heartburn and acid indigestion associated with GERD and to prevent the formation of ulcers.
What is a common histamine H2 antagonist?
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Examples of histamine H2 antagonists include cimetidine (Tagamet), famotidine (Pepcid), and ranitidine (Zantac). Pepcid is the histamine H2 antagonist most commonly prescribed in the long term care area.
Are there any side effects associated with histamine H2 antagonists?
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Side effects are usually minimal. A small percentage of people may develop dizziness, headache, confusion, or diarrhea. Persons with renal impairment are more likely to develop these adverse reactions.
Are there any drug interactions associated with histamine H2 antagonists?
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Giving histamine H2 antagonists with an antacid may decrease the absorption of the histamine H2 antagonist. Giving with opoids increases the risk of respiratory depression. Histamine H2 antagonists may also decrease the effectiveness of digoxin. Histamine H2 antagonists are known to increase bleeding times of persons receiving anticoagulant therapy.
What is the onset and duration of action of famotidine (Pepcid)?
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Famotidine (Pepcid) does not provide immediate relief. Onset may be as long as one hour but the effects last twelve hours or longer. Famotidine (Pepcid) is usually taken not prn but on a daily schedule.
Are there any other nursing considerations concerned with famotidine (Pepcid)?
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Pepcid AC gel caps should not be crushed or chewed. If the patient cannot swallow the tablet whole, consider the liquid or chewable form of famotidine.
What is a proton pump inhibitor?
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A proton pump inhibitor, like a histamine H2 antagonist, reduces the secretion of stomach acid. Chemically, they work on different cells than the histamine H2 antagonists.
What is the most common use of a proton pump inhibitor?
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Gastric and duodenal ulcers
Gastroesophageal reflux disease (GERD) and erosive esophagitis
Pathological hypersecretory conditions
What is a common proton pump inhibitor?
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Examples of proton pump inhibitors include esomeprazole (Nexium), lansoprazole (Prevacid), and omeprazole (Prilosec). Omeprazole (Prilosec) is the proton pump inhibitor example discussed in this section.
Are there any side effects associated with proton pump inhibitors?
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The side effects of proton pump inhibitors are similar to the side effects of histamine H2 antagonists. They include headache, nausea, diarrhea, and abdominal pain. In addition, proton pump inhibitors may decrease the body’s ability to absorb vitamin B12, leading to anemia.
Are there any drug interactions associated with proton pump inhibitors?
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Drug-drug interactions include
Ampicillin (decreased absorption of ampicillin)
Anticoagulants (increased risk of bleeding)
Digoxin (increased absorption of digoxin, increased risk of digitalis toxicity)
Dilantin (increased dilantin serum levels, increased risk of dilantin toxicity)
As expected, persons with renal impairment are more likely to develop toxic levels of medications.
What is the onset and duration of action of omeprazole (Prilosec)?
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Omeprazole (Prilosec) does not provide immediate relief. Relief may be as long as three to four days. Omeprazole (Prilosec) should be taken once daily.
Are there any other nursing considerations concerned with omeprazole (Prilosec)?
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Omeprazole (Prilosec) should be taken before meals, preferably before breakfast, with a full glass of water. Omeprazole (Prilosec) capsules come in timed-release capsules. Do not chew the contents of the capsule. The contents may be sprinkled into applesauce, but then should be immediately swallowed. Allowing the beads to sit in the applesauce for any length of time will cause the medication to dissolve, thus releasing all of the medication at the same time.
Are there general nursing considerations with the use of all antacids, histamine H2 antagonists, and proton pump inhibitors?
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Any episode of heartburn or indigestion may be indicative of a myocardial infarction. Carefully assess the cardiac status. Monitor the vomitus and stools for occult blood. Persons should not take histamine H2 antagonists or proton pump inhibitors for more than 14 days unless instructed to do so by a physician.
The GI System - Antacids, Histamine H2 Antagonists, and Proton Pump Inhibitors
Roach, Chapter 47 (pages 514 - 521)
What is an antacid?
What conditions or disorders may be treated with antacids?
Gastroesophageal reflux disease (GERD)
Peptic ulcer
What are some common antacids?
Maalox
Mylanta
Amphojel
Tums is an example of a solid antacid.
What are the active ingredients in antacids?
Are there any side effects of antacids?
Taking too much of any antacid, or persons with impaired renal failure who have difficulty excreting waste products, may experience more serious symptoms of mineral toxicities. Rebound hyperacidity may also occur.
What is rebound hyperacidity?
Is there any preparation prior to administering an antacid?
What about the anatacid tablets that dissolve and ‘fizz’ in water?
Should an antacid be given prior to a meal, with a meal, or after a meal?
How should an antacid be given?
What is the onset of action for antacids?
Are there any drug – drug interactions with antacids?
What is a histamine H2 antagonist?
What is the most common use of a histamine H2 antagonist?
What is a common histamine H2 antagonist?
Are there any side effects associated with histamine H2 antagonists?
Are there any drug interactions associated with histamine H2 antagonists?
What is the onset and duration of action of famotidine (Pepcid)?
Are there any other nursing considerations concerned with famotidine (Pepcid)?
What is a proton pump inhibitor?
What is the most common use of a proton pump inhibitor?
Gastroesophageal reflux disease (GERD) and erosive esophagitis
Pathological hypersecretory conditions
What is a common proton pump inhibitor?
Are there any side effects associated with proton pump inhibitors?
Are there any drug interactions associated with proton pump inhibitors?
Ampicillin (decreased absorption of ampicillin)
Anticoagulants (increased risk of bleeding)
Digoxin (increased absorption of digoxin, increased risk of digitalis toxicity)
Dilantin (increased dilantin serum levels, increased risk of dilantin toxicity)
As expected, persons with renal impairment are more likely to develop toxic levels of medications.
What is the onset and duration of action of omeprazole (Prilosec)?
Are there any other nursing considerations concerned with omeprazole (Prilosec)?
Are there general nursing considerations with the use of all antacids, histamine H2 antagonists, and proton pump inhibitors?
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